Permanent pacemaker implantation after cardiac surgery: An analysis of 103 cases / 第二军医大学学报

ABSTRACT

Objective To explore the factors influencing the implantation of permanent pacemaker in patients after cardiac surgery, and the timing and approach of pacemaker for early implantation. Methods Patients undergoing permanent pacemaker implantation (excluding implanted defibrillators and cardiac resynchronization therapy) after cardiac surgery between Jan. 2007 and Dec. 2016 were retrospectively enrolled, and their clinical data were collected, including gender, age, clinical diagnosis, preoperative heart rhythm, type of cardiac surgery, indication of pacemaker implantation, duration from cardiac surgery to pacemaker implantation, and type of permanent pacemaker. According to the time between cardiac surgery and pacemaker implantation, the patients were divided into three groups early group (≤1 month), midterm group (1 month to 1 year) and long-term group (>1 year). The type of cardiac surgery and the indication of pacemaker implantation were compared between the three groups. Results A total of 103 patients were included in this study, among which 86 cases received valvular surgery, 9 received surgery for congenital heart disease, and 8 received coronary artery bypass grafting (CABG). Twenty-two patients (21.36%) had sick sinus atrial node syndrome, and 81 patients (78.64%) had atrioventricular block. Sixty-eight cases (66.02%) had grade III or advanced atrioventricular block, including 29 (28.16%) atrial fibrillation with long RR interval, and 13 cases (12.62%) had atrial fibrillation with slow ventricular rate. Twenty-sevenpatients (26.21%) were included in the early group, 16 patients (15.53%) in the mid-term group, and 60 patients (58.25%) in the long-term group. There were no significant differences in the proportions of aortic valve surgery, double valve surgery or more complex surgery (including valve replacement or valve plasty) between the three groups (all P>0.05). The proportion of atrioventricular block was higher among the pacemaker implantation indications, and the difference in the proportion of atrioventricular block among the three groups was statistically significant (χ2=6.089, P=0.048). The average time between surgery and implantation of patients in the early group was (13.43±7.24) d, and the major approach for implanting electrode leads was elective percutaneous endocardial implantation after surgery (25 cases), occasionally the electrode leads was implanted during the surgery (one case of endocardial leads and one case of epicardial leads). Conclusion Atrioventricular block is the most common indication of permanent pacemaker implantation after cardiac surgery. Reasonable time is required for recovery of atrioventricular conduction or sinus node function before early implantation. Major approach for implanting endocardial leads is elective percutaneous endocardial implantation; if necessary, endocardial or epicardial leads can be implanted during surgery.